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0 0.5 1 1.5 2+ 5 or 10 day remdesivir vs... 35% Improvement Relative Risk Remdesivir  Spinner et al.  LATE TREATMENT  RCT Is late treatment with remdesivir beneficial for COVID-19? RCT 584 patients in multiple countries (March - April 2020) Lower mortality with remdesivir (not stat. sig., p=0.5) Spinner et al., JAMA, August 2020 Favors remdesivir Favors control

Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19A Randomized Clinical Trial

Spinner et al., JAMA, doi:10.1001/jama.2020.16349
Aug 2020  
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Late stage (median 8 days from symptom onset) RCT 584 patients with moderate COVID-19 showing (non-statistically significant) lower mortality.
5-day remdesivir had significantly higher odds of a better clinical status distribution on the 7-point ordinal scale, odds ratio OR 1.65, p = 0.02. The difference for 10-day remdesivir was not statistically significant, p=0.18.
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
5 or 10 day remdesivir vs. control 28 day mortality, 34.9% lower, RR 0.65, p = 0.50, treatment 5 of 384 (1.3%), control 4 of 200 (2.0%), NNT 143, day 28.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Spinner et al., 21 Aug 2020, Randomized Controlled Trial, multiple countries, peer-reviewed, 30 authors, study period 15 March, 2020 - 18 April, 2020, average treatment delay 8.0 days.
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This PaperRemdesivirAll
Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19
MD Christoph D Spinner, MD Robert L Gottlieb, PhD Gerard J Criner, José Ramón Arribas López, MD Anna Maria Cattelan, MD Alex Soriano Viladomiu, MD Onyema Ogbuagu, MD Prashant Malhotra, DO; Kathleen M Mullane, MD Antonella Castagna, Louis Yi Ann Chai, MD Meta Roestenberg, Owen Tak Yin Tsang, MD Enos Bernasconi, MD; Paul Le Turnier, MD Shan-Chwen Chang, MD Devi Sengupta, DPhil Robert H Hyland, MD Anu O Osinusi, MD Huyen Cao, MS Christiana Blair, PhD Hongyuan Wang, MD, PhD; Anuj Gaggar, MD Diana M Brainard, MD Mark J Mcphail, MD Sanjay Bhagani, MD Mi Young Ahn, MD Arun J Sanyal, MD; Gregory Huhn, MD Francisco M Marty
JAMA, doi:10.1001/jama.2020.16349
IMPORTANCE Remdesivir demonstrated clinical benefit in a placebo-controlled trial in patients with severe coronavirus disease 2019 (COVID-19), but its effect in patients with moderate disease is unknown. OBJECTIVE To determine the efficacy of 5 or 10 days of remdesivir treatment compared with standard care on clinical status on day 11 after initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label trial of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (pulmonary infiltrates and room-air oxygen saturation >94%) enrolled from March 15 through April 18, 2020, at 105 hospitals in the United States, Europe, and Asia. The date of final follow-up was May 20, 2020. INTERVENTIONS Patients were randomized in a 1:1:1 ratio to receive a 10-day course of remdesivir (n = 197), a 5-day course of remdesivir (n = 199), or standard care (n = 200). Remdesivir was dosed intravenously at 200 mg on day 1 followed by 100 mg/d. MAIN OUTCOMES AND MEASURES The primary end point was clinical status on day 11 on a 7-point ordinal scale ranging from death (category 1) to discharged (category 7). Differences between remdesivir treatment groups and standard care were calculated using proportional odds models and expressed as odds ratios. An odds ratio greater than 1 indicates difference in clinical status distribution toward category 7 for the remdesivir group vs the standard care group. RESULTS Among 596 patients who were randomized, 584 began the study and received remdesivir or continued standard care (median age, 57 [interquartile range, 46-66] years; 227 [39%] women; 56% had cardiovascular disease, 42% hypertension, and 40% diabetes), and 533 (91%) completed the trial. Median length of treatment was 5 days for patients in the 5-day remdesivir group and 6 days for patients in the 10-day remdesivir group. On day 11, patients in the 5-day remdesivir group had statistically significantly higher odds of a better clinical status distribution than those receiving standard care (odds ratio, 1.65; 95% CI, 1.09-2.48; P = .02). The clinical status distribution on day 11 between the 10-day remdesivir and standard care groups was not significantly different (P = .18 by Wilcoxon rank sum test). By day 28, 9 patients had died: 2 (1%) in the 5-day remdesivir group, 3 (2%) in the 10-day remdesivir group, and 4 (2%) in the standard care group. Nausea (10% vs 3%), hypokalemia (6% vs 2%), and headache (5% vs 3%) were more frequent among remdesivir-treated patients compared with standard care. CONCLUSIONS AND RELEVANCE Among patients with moderate COVID-19, those randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with standard care at 11 days after initiation of treatment. Patients randomized to a 5-day course of remdesivir had a statistically significant difference in clinical status compared with..
ARTICLE INFORMATION Accepted for Publication: August 12, receiving grants from Galectin and Bristol-Myers; consulting for Conatus, Gilead, Pfizer, Boehringer Ingelheim, Merck, Hemoshear, Lilly, Novo Nordisk, Ardelyx, Terns, ENYO, Birdrock, Albireo, Sanofi, Janssen, Takeda, Zydus, AMRA, Poxel, Servier, Second Genome, and General Electric; receiving grants and consulting for Mallinckrodt, Salix, Novartis, and Nimbus; being principal investigator of an ongoing trial for Genfit; receiving grants and being principal investigator of an ongoing trial for Immuron; receiving grants, consulting for, and being principal investigator of ongoing trials for Echosens-Sandill and Sequana; providing advice but receiving no personal remuneration for Intercept, Galectin, Fractyl, Durect, Indalo, Allergan, Chemomab, Affimmune, Teva, BASF, Perspectum, and 89bio; and being the inventor for a patent held jointly by OWL and Virginia Commonwealth University. Dr Huhn reported that his institution received grants from Gilead, GlaxoSmithKline/ViiV, Janssen, Bristol-Meyers Squibb, Proteus, Lilly, and the National Institute of Allergy and Infectious Diseases and that he received consulting fees from Gilead, ViiV, Janssen, and Theratechnologies. Dr Marty reported receipt of grants from Ansun, Chimerix, Gilead, and Merck and personal fees from AlloVir, Janssen, Kyorin, Merck, ReViral, and Symbio. Drs SenGupta, Hyland, Osinusi, Cao, Blair, Wang, Gaggar, and Brainard are employees of and own stock in Gilead..
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Late treatment
is less effective
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